The Future of pharmacy practice in
the state of wisconsin

The Medical College of Wisconsin (MCW) School of Pharmacy intends to become a destination program for pharmacy education, research and practice by engaging students, practitioners and researchers through the continuum of discovery to care. Collectively and collaboratively we intend to create a dynamic academic pharmacy program that will advance the profession and improve patient care in the State of Wisconsin and beyond. Our aim: to graduate “practice ready and team ready” pharmacists.

Our intentions are to not only produce the pharmacy graduates of the future, but also create practice models and teams in conjunction with our pharmacy and medical colleagues, other healthcare providers and institutions that desire to leverage the role of the pharmacist to achieve better health outcomes in patients. We will not engage in this transformation alone. It will include our partners on the Milwaukee Regional Medical Campus, our regional medical school campuses in Green Bay and Wausau, hospitals, community pharmacies, healthcare agencies, communities, organizations throughout the State (such as the Pharmacy Society of Wisconsin), payers, and other academic programs that share our vision and passion to advance pharmacist models of care.

Academic pharmacy must ensure that PharmD graduates possess the knowledge, skills, and attitudes requisite for contemporary practice including the ability to contribute to an ever-evolving healthcare system. To use a sports analogy, healthcare is a very complex team sport, with multiple individuals playing many different roles, coming in and out of contact with one another at various times while sharing a common goal – the patient’s wellbeing.

Pharmacists do and can play an increasing role in this model of care. Immunization certification is requisite in the pharmacy job market today, yet was not required 10-15 years ago. What will be expected of future pharmacists? More aptly stated, what skill set is needed to participate in patient-centered/team-based healthcare delivery?

The profession must continue to transform from one of product distribution to service provision. The ability by pharmacists to ensure the intended outcomes of prescribed therapies, must go beyond providing product alone. In the words of Former US Surgeon General Dr. C. Everett Koop, “Medications don’t work in patients who don’t take them.” Yet, access to medications is only part of the solution, having a uniquely educated professional (i.e., pharmacist) to ensure adherence and desired outcomes are attained is a critical factor to consider. Cautionary note: Having pharmacists oversee the number one intervention in healthcare (i.e., prescription medications) makes sense, though other healthcare providers can and will assume this role if abdicated by the profession.

The future of healthcare will require pharmacy graduates to have the ability to contribute meaningfully to patient care, public health, and personalized/precision medicine in all settings. I envision an evolution into Primary Care Pharmacy services provided in rural and urban areas that leverage the role and accessibility of the pharmacist. Future Primary Care Pharmacist Practitioners (PCPPs) will provide point-of-care testing for chronic and acute conditions such as infectious diseases. The ability to reach targeted populations and predict infectious outbreaks through GPS heatmaps (i.e., Strep throat, H. Flu) and other chronic infectious diseases (i.e., HIV, Hep C) serves the Public Health welfare. As a public health initiative, we must play an active ongoing role along with our healthcare colleagues to reduce prescription medication abuses that are running rampart in our communities. Shortly, pharmacists in all settings will help create personalized approaches to customize patient medication regimens based on genomic profiles.

I too envision a continuum of PCPPs expanding from pharmacies into medical offices engaged in direct-patient care and virtual-patient care. The VA has used this model for over 40 years. Pharmacists must be comfortable to engage in telehealth, ensuring access to needed healthcare services in underserved areas via these new emerging technologies. How useful it would be via PCPP teleconsult to show to a physician: a heart failure patient’s lower leg pitting edema requiring diuresis; adjustment of medications for a CHD patient following point-of-care testing for cholesterol and blood pressure measurements; or remote retinal scanning of a diabetic?

Yet for many of these transformations to occur, pharmacists need to be recognized under the Social Security Act as healthcare providers with passage of “The Pharmacy and Medically Underserved Areas Enhancement Act.” Pharmacists and future pharmacists must take an active role by contacting their respective legislators to support this Act

I will know that we have made fundamental changes in the profession when patients can schedule to see a pharmacist who is reimbursed for professional services (i.e., without a prescription) to review medications suggest changes, deletions, additions, use of point-care-testing, and wearables/Apps. I envision annual reviews by pharmacists in our high-risk patients such as the elderly and those with chronic conditions/co-morbidities to identify medication related problems before patients experience negative outcomes. We need not look far for a model, the preventive dental care model, where twice a year potential dental issues are identified before they emerge as problems.

Many of the concepts described above while appearing futuristic, have been planned for incorporation into the MCW School of Pharmacy doctor of pharmacy curriculum.

I look forward to colleagues within the State to share their opinions with me.